Updating risk prediction tools a case study in prostate cancer
We excluded articles describing models for predicting the risk of venous disease; validation articles with a cross sectional study design that, for example, compared predicted risks of two different models at one time point without any association with actual CVD outcomes; and articles describing models developed from or validated exclusively in specific diseased (patient) populations, such as patients with diabetes, with HIV, with atrial fibrillation, or undergoing any surgery.
Furthermore, we excluded methodological articles and articles for which no full text was available through a license at our institutes.
In the United Kingdom, electronic health patient record systems now have QRISK2 embedded to calculate 10 year CVD risk.
Several reviews have shown that there is an abundance of prediction models for a wide range of CVD outcomes.12 13 14 However, the most comprehensive review12 includes models published more than 10 years ago (search carried out in 2003).
Only 132 developed models (36%) were externally validated and only 70 (19%) by independent investigators.
Model performance was heterogeneous and measures such as discrimination and calibration were reported for only 65% and 58% of the external validations, respectively.
The most common predictors were smoking (n=325, 90%) and age (n=321, 88%), and most models were sex specific (n=250, 69%).In case of doubt, a second (JAAGD or GSC) or third (ES or KGMM) reviewer was involved.We categorised the eligible articles into two groups: development articles, and external validation (with or without model recalibration) articles.Articles published before 2004 were identified from a previously published comprehensive systematic review,12 and a cross reference check was performed for all reviews on CVD prediction models identified by our search.For external validation studies where the development study was not identified by our search, we manually retrieved and included in the review the original article describing the development of the model.
Disagreements were resolved by iterative screening rounds.